The U.S. death rate rose last year for the first time in a decade. This led to the first drop in life expectancy since 1993. The typical American in 2015 can expect to live 78.8 years, down slightly from 78.9 years in 2014. Heart disease and cancer remain the leading causes of death in the United States.

To highlight how life expectancy trends vary across the United States, 24/7 Wall St. listed the city in every state with the shortest life expectancy at birth. Across all metro areas, life expectancy is lowest in Gadsden, Alabama, where life expectancy at birth is only 73.3 years. By contrast, average life expectancy in Naples-Immokalee-Marco Island, Florida is more than 10 years longer.

Wealthier individuals tend to be healthier, and poorer individuals less healthy. In the poorer end of the income spectrum, especially for those living in poverty, income has an outsized impact on health. Adults living in poverty are nearly five times more likely to report being in poor or fair health than more affluent adults. The cities on this list tend to have lower household incomes and a larger share of residents living in poverty than metro areas with longer life expectancies. Median household incomes are lower than the national median in all but nine of the 50 cities.

Another common trend among the cities with the shortest life expectancy in their state is the tendency to report more unhealthy behaviors than cities with longer life expectancies. Inactivity and unhealthy eating contribute to higher obesity rates, which in turn increase the risk of life-shortening diseases. Of the 50 cities with the shortest life expectancy in their state, 40 have higher obesity rates than the nation as a whole.

While every city on this list has the shortest life expectancy in their state, these life expectancies are not necessarily short in a national context. For example, because life expectancy is so high across Massachusetts, even in Pittsfield — the city with the shortest life expectancy in the state — residents are expected to live longer than the typical American.

To determine the metropolitan areas in each state where people have the lowest life expectancy, 24/7 Wall St. reviewed 2013 county-level life expectancy at birth figures provided by the Institute for Health Metrics and Evaluation (IHME), a global research center affiliated with the University of Washington. Using death records data from the National Center for Health Statistics, researchers applied a mixed effects Poisson statistical model and Gaussian Process Regression to estimate age-specific mortality rates for U.S. counties from 1985 to 2013.

To obtain metro area life expectancy estimates, we mapped the counties to their corresponding metro areas and calculated the average life expectancy by sex across all counties in a given metro area. County estimates were weighted by 2013 5-year population figures from the American Community Survey (ACS). To ensure 2008 and 2013 life expectancy estimates were comparable, both estimates were weighted by populations in 2013.

Metro-level median household income came from the U.S. Census Bureau’s 2015 American Community Survey. Obesity rates came from County Health Rankings & Roadmaps program, a collaboration between the Robert Wood Johnson Foundation and the University of Wisconsin Population Health Institute.